Is it possible to get pregnant with a broken leg? Falling on your back or side during pregnancy. What can you do

The topic of injury during pregnancy is unreasonably ignored by doctors, although in most cases such injuries can be prevented. After all, up to 20% of deaths of pregnant women occur due to injuries and damage not related to pregnancy.

Most often, women suffer injuries during pregnancy as a result of road traffic accidents (RTA). Fortunately, the incidence of pregnant women involved in road accidents, the degree of injury and the number of deaths do not exceed those of non-pregnant women.

Not inferior to road accidents in frequency are injuries associated with physical violence from a husband or partner and usually received at home. In developed countries, cases of injury as a result of physical violence occur in 5-30% of pregnant women, but still the majority of such incidents, especially with minor injuries, remain unpublicized and are not mentioned when visiting a doctor. In 64% of such cases, the woman receives blows to the abdominal area. Fetal death occurs in one out of 20 pregnant women.

In third place are falls and accidental injuries. As pregnancy progresses and the uterus grows, a woman’s center of gravity shifts, which leads to increased loss of balance. From 3 to 30% of falls are accompanied by injury, and the period after 32 weeks of pregnancy is especially dangerous.

Domestic and other types of injuries are rare in pregnant women, and the degree of damage is determined by the type of injury. The most dangerous are electric shocks, since more than 70% of such accidents result in the death of the fetus.

Despite the increased frequency of injuries to pregnant women, the consequences of injury during pregnancy for women’s health are less serious compared to injuries to non-pregnant women. Doctors explain this effect by the protective function of increased hormonal levels, as well as more frequent visits by pregnant women to medical institutions. Even with minor bruises and injuries, a pregnant woman is more likely to undergo a timely examination and receive the necessary help compared to other groups of people.

The extent of damage when injured depends on many factors. However, the duration of pregnancy plays a very important role. In the first trimester, while the uterus is within the pelvis, with blows, falls, or short-term compression of the abdomen, the risk of harm to the pregnancy will be minimal. Up to 3% of women who are injured and hospitalized due to it do not know that they are pregnant. The doctor is obliged to check with the woman, if her condition allows it, whether she is being protected from pregnancy and when she had her last menstruation. If menstruation is delayed, the hCG level is determined to determine the presence of pregnancy.

In the second trimester, the uterus already extends beyond the pelvis, but nevertheless, the fetus is surrounded by a sufficient amount of amniotic fluid, which softens the force of falls and blows, so the danger to the fetus in this period of pregnancy is also not too high.

In the third trimester and before childbirth, trauma can lead to premature birth, placental abruption, bleeding, uterine rupture, and intrauterine fetal death.

In the second half of pregnancy, if damage occurs, it is important where exactly the placenta is attached. Most often, the baby's place is located on the back wall of the uterus - this is one of nature's protective mechanisms. But in a number of women, the placenta is attached to the anterior wall of the uterus, which significantly increases the risk of placental abruption due to abdominal trauma. Particular attention should be paid to the abnormal attachment of the placenta - the so-called presentation, which in itself can be accompanied by a number of complications, but with injuries these complications appear more often.

What should a pregnant woman do if she is injured as a result of a fall, accident, impact, etc.? To begin with, it is important to correctly assess the degree of harm to your own health and the health of the unborn child. Of course, the reaction of many women, especially in a state of shock, may be inadequate, so in such cases it is advisable to immediately contact a medical facility.

If the injury is not accompanied by pain, bleeding, or increased contractile activity of the uterus, the woman can lie down and monitor her condition and fetal movements, if she felt them before. It is important to remember that from the second half of pregnancy, an enlarged uterus can compress the inferior vena cava when the woman lies on her back, and this in 30% of cases is accompanied by unpleasant symptoms and creates a false picture of a worsening condition.

However, if you receive an injury, it is still undesirable to take any painkillers. If the impact of a fall or accident falls directly on the abdominal area and the woman experiences severe pain, it is necessary to call an ambulance or immediately go to the hospital on your own.

Up to 40% of pregnant women may experience increased uterine contractions after injury, but in 90% of cases these contractions will stop without negative consequences for the pregnancy.

In a medical institution, the doctor is obliged to assess the woman’s condition and, if necessary, connect her to oxygen and intravenous drips. But it is very important to know the condition of the fetus, placenta, and amniotic fluid. In this case, ultrasound will be one of the best diagnostic methods. If the pregnancy is more than 23-25 weeks, the woman may be sent to the maternity ward for observation, even with minor injuries.

Ultrasound allows you to determine not only the condition of the uterus, placenta, fetus, but also intra-abdominal bleeding. It is important to monitor the fetal heart rate: the mother's stress reaction can be reflected in the form of a stress reaction in the fetus. After 23-34 weeks of pregnancy, monitoring of the fetus and its activity is carried out for 4 hours, and if necessary, longer.

After injury, short-term disturbances in the fetal heart rhythm may be observed, but such deviations, as a rule, do not have a negative prognostic value. At the same time, a normal heart rhythm excludes a negative outcome of pregnancy due to injury.

Most types of examinations that are used in medicine to assess a patient's condition after injury are safe during pregnancy. Most often, women are concerned about the dangers of X-ray examination. Clinical studies show that x-rays of the pelvis, spine, and hips in the early stages of pregnancy (5-10 weeks) increase the rate of miscarriages and the occurrence of malformations. After 10 weeks, the effect of radiation is characterized by changes in the central nervous system of the fetus. The level of negative effects of radiation on the fetus depends on the radiation dose.

Computed tomography also carries an increased risk of radiation exposure, although to a lesser extent than x-rays. However, any type of examination that involves exposure to fetal radiation should be performed carefully and according to strict indications.

A very important issue that is often missed by both doctors and women is the prevention of Rh sensitization, which is popularly called Rh conflict. All pregnant women from 6 weeks of pregnancy with a Rh-negative blood group after injury are recommended to administer 300 mg of anti-Rhesus antibodies (immunoglobulins), since in such cases damage to the placenta cannot be ruled out.

According to indications, tetanus prophylaxis should be carried out in injured pregnant women. This type of vaccine is safe for pregnancy.

In almost 30% of cases with moderate injuries and in more than 60% of cases with severe injuries, pregnancy will end in termination with loss of the fetus, while minor injuries will not affect the course of pregnancy and its outcome. Up to 20% of pregnant women requiring hospital treatment lose their pregnancies, since hospital treatment is usually required only in severe cases. However, even minor trauma doubles the risk of premature birth. Up to 7% of pregnant women require a cesarean section soon after injury.

Prevention of all types of injuries and damage in pregnant women is no different from that in other people. More attention is paid to the prevention of falls, so all women, starting from the second half of pregnancy, are recommended to wear low-heeled shoes, be extra careful when using stairs, limit sudden movements, as well as physical activity that is accompanied by a high risk of falling (biking, skating, skiing, horse riding, jumping, running, etc.). When in transport, with the exception of public transport, a pregnant woman must wear seat belts. Physical violence and abuse of power must be promptly identified and suppressed by all appropriate measures, including the intervention of law enforcement agencies, social services, family counselors and other professionals.

In general, minor injuries do not have an adverse effect on pregnancy, and the woman calmly gives birth to a healthy, full-term baby.

Fractures during pregnancy A fracture during pregnancy is a serious problem. But, fortunately, the incidence of fractures in pregnant women is still lower than the incidence of similar injuries in non-pregnant women. This is explained by the special protective mechanisms that are triggered in the body of the expectant mother, and by the greater caution of the woman. Contrary to popular belief, bone fragility does not increase with time, but, on the contrary, the bones of the legs and arms become denser and stronger. Therefore, it is not so easy to break any part of the skeleton upon impact. But sometimes injuries do occur, and it is important for the expectant mother to know the first signs of a fracture of a particular bone, safe treatment methods and tactics of behavior if a fracture is suspected, in order to seek help in time and preserve her health and the health of her unborn baby.

Symptoms of a fracture

The cause of a fracture in pregnant women is most often a fall - a change in weight, a shift in the center of gravity, and can lead to loss of coordination and a fall. Symptoms of a closed fracture usually very characteristic - sharp severe pain at the fracture site, numbness and impaired mobility of the affected limb, severe swelling and cyanosis at the fracture site. With significant displacement of bone fragments, deformation in the area of injury is noticeable.

With an open fracture The integrity of the skin is compromised, and the edges of bone fragments are visible from the wound. Often an open fracture is accompanied by severe bleeding and painful shock, so first aid should be provided immediately.

The main differences in treatment for fractures during pregnancy depend on the location of the fracture, the duration of pregnancy, and the severity of the injury.

Arm fractures in pregnant women

Most often, pregnant women suffer from fractures in their arms - after all, when there is a threat of falling, the woman intuitively groups herself and puts her arms forward to protect her stomach from a blow. As a result, a fracture of any bone in the upper shoulder girdle can occur - from the wrist to the collarbone, it all depends on the force of the impact during the fall, the position of the body and the presence of obstacles at the site of the fall.

When a pregnant woman breaks her arm, a plaster cast or splint is most often applied (depending on the location of the fracture). Sometimes the displacement of the broken bone fragments is very strong and surgery is required to properly align them. In this case, the traumatologist, together with the gynecologist, decides on treatment tactics, the possibility of surgical intervention and, depending on the stage of pregnancy at which the fracture occurred, management tactics.

Leg fracture during pregnancy

A leg fracture during pregnancy is one of the most severe and “inconvenient” injuries. In terms of frequency, leg fractures in pregnant women rank second among similar injuries in expectant mothers. Most often the foot and ankle are affected, but more severe fractures also occur - fractures of the femoral neck, femur, and tibia.

Treatment of a leg fracture in pregnant women is usually complicated by the need for prolonged immobilization and traction. Together with plaster casts, devices for compression-distraction osteosynthesis (wires, plates, Ilizarov apparatuses) are often used. Depending on the duration of pregnancy and the severity of the fracture, doctors in each specific case make an informed decision about the possibility of performing an operation and determining the tactics of childbirth if the fracture occurs in the later stages.

Fractures of fingers and toes during pregnancy

Surprisingly, finger fractures in pregnant women do not occur very often. This usually happens due to negligence, as a result of a strong blow (for example, with a door on the fingers or when kicking some obstacle). Symptoms of a finger fracture are common - severe pain, swelling, hematoma, disruption of normal function. Treatment most often consists of applying a plaster splint or splint to fix the affected finger.

Rib fracture during pregnancy

Very often, expectant mothers are bothered by pain in the ribs in the late stages of pregnancy, and, accordingly, the woman has a question - maybe the baby broke a rib from the inside? In fact, if the ribs are not injured before pregnancy, the mother does not have serious diseases that affect the strength of the bones, and she is not wearing Hercules or the Hulk, then there is nothing to fear. But getting a rib fracture during pregnancy due to injury is quite possible. The main causes of rib fractures are a blow or strong compression in the chest area (from a fall, an accident or a strong hug).

Symptoms of a rib fracture specific for this injury:

Corset plaster casts are rarely applied during pregnancy. For uncomplicated rib fractures, tight bandaging with an elastic bandage or special bandages is often used.

A severe displaced rib fracture can lead to pleural rupture and even lung injury. In this case, other symptoms appear - scarlet foam on the lips, pneumothorax,. This condition requires immediate assistance from a qualified specialist.

Injuries of the spine, pelvis and skull in pregnant women

Such injuries occur very rarely, mainly in road accidents or other emergency situations. If you suspect such an injury, under no circumstances should you move the victim, change the position of your body, or try to lift yourself. In case of such injuries, pregnancy is maintained only if there is no threat to the life of the mother.

What increases the risk of fractures in pregnant women

Many people believe that during pregnancy, the baby “eats” calcium from the mother’s body, so her bones become fragile and often break. In fact, nature has provided protective mechanisms, and while carrying a child, the mother’s skeleton acquires special properties that allow it to maintain the strength of bone tissue in conditions of increased calcium consumption. However, there are diseases in which bone fragility increases - osteoporosis, incomplete osteogenesis, impaired mineral metabolism. In such cases, even a slight blow or awkward movement can lead to a fracture.

X-ray for a fracture in pregnant women - to do or not

For fractures, the main diagnostic method is an x-ray in two projections. But if this is a fracture in a pregnant woman, then when prescribed, doubts immediately arise about the safety of this procedure for her baby. In fact, it still remains the most accessible and reliable way to diagnose fractures (bone fractures are only possible with special equipment, and the accuracy of diagnosis depends on the qualifications of the doctor). Therefore, for pregnant women, there are ways to protect the fetus during the procedure - the mother’s belly is always protected with a lead apron, which prevents the effect of radiation on the fetus. During pregnancy prior to pregnancy, x-rays are prescribed only if it is impossible to diagnose a fracture based on examination or for health reasons.

Treatment of fractures in pregnant women

The basic principles of treating fractures in pregnant women are the same as when treating injuries under normal conditions:

For complex and severe fractures during pregnancy, the main method of treatment is surgery using the method of immersion osteosynthesis. Installed clamps allow the expectant mother to maintain relative mobility. This method also reduces the risk of developing a serious complication – thromboembolism.

Fractures are always accompanied by severe pain, so it is necessary to prescribe painkillers. During pregnancy, their choice is very limited, since almost all drugs are contraindicated during pregnancy. But if necessary, they prescribe nimesulide, with diphenhydramine by injection, ketanov. Attention! – before using these drugs, consultation with a doctor is required. It is recommended to apply ice on the first day after injury - it will help relieve pain and swelling.

For open fractures, antibiotics are necessary to prevent infection in the wound. During pregnancy, Amoxiclav, Emsef, and Ceftriaxone are most often prescribed.

Traditional methods of treating fractures during pregnancy

Traditional medicine is rich in various recipes for the treatment of fractures, but not all of them are suitable for treating injuries in pregnant women. One of the relatively safe ways to numb a fracture is to rub fir oil into the skin above and below the fracture area. Also, lotions and applications with mumiyo solution have proven themselves to be effective. It is worth emphasizing that many folk recipes for treating fractures during pregnancy are simply dangerous for the unborn child, so you should not take risks and conduct experiments.

This is a partial or complete violation of the integrity of the bone components of the pelvic ring, caused by exposure to excessive mechanical loads. It manifests itself as local pain at the site of injury, swelling, hematoma, limited movement, and in severe injuries - confusion or loss of consciousness, increasing signs of shock. Diagnosed using MRI of the pelvis and pelviography. To stabilize the pregnant woman's condition, infusion, analgesic, and tocolytic therapy is prescribed, after which conservative or surgical reposition of the fragments is performed.

ICD-10

S32.3 S32.5 S32.7 S32.8

General information

In recent decades, industrialized countries have seen a steady increase in injury rates, including among pregnant women. According to the observations of specialists in the field of obstetrics, up to 7% of women receive various types of fractures during gestation. Trauma is one of the leading non-obstetric causes of maternal mortality - more than 18% of deaths among pregnant women are caused by trauma and its complications. One of the most severe traumatic disorders during pregnancy, leading to blood loss, shock, and fetal loss, is considered to be fractures of the pelvic bones, especially if they are combined with damage to internal organs and other parts of the musculoskeletal system.

Causes

The integrity of the bone elements of the pelvic ring is partially or completely disrupted under the influence of loads whose strength exceeds the strength of the bone tissue. Typically, damage to the pelvis results from strong compressive or impact forces, or, less commonly, from altered bone architecture with a decrease in strength characteristics. According to the observations of traumatologists, fractures during pregnancy are caused by:

Injuries. In 53-56% of patients, damage to the pelvic bones is caused by road traffic accidents: direct impact from protruding parts, collision with a pedestrian, compression by structural elements of a car when crushed in an accident, throwing of the victim. Fractures also occur when a pregnant woman falls from a height or gets gunshot wounds. Damage is often combined or combined.
Pathological birth. The passage of the fetus through the birth canal is accompanied by significant pressing and bursting loads on the pelvic bones. The likelihood of a fracture of the coccyx or pubic bones increases during prolonged labor in women in labor with a clinically or anatomically narrow pelvis, emergency application of obstetric forceps, vacuum extraction of the fetus, extraction of the child by the pelvic end, and performance of fetal-destroying operations.
Diseases of the pelvic bones. The resistance of the pelvic bones to stress decreases when they are destroyed due to pathological processes: bone tuberculosis, osteodystrophy, malignant tumors, osteomyelitis, tertiary syphilis, osteoporosis of various origins. Pathological fractures that occur due to minor impacts and caused by the restructuring of the bone structure are extremely rare in pregnant women.

An additional factor that increases the risk of bone fractures during the gestation period and slows down the restoration of damaged bone tissue is physiological calcium deficiency, which is intensively consumed during the formation of the fetal musculoskeletal system. Hypocalcemia is more pronounced with a lack of natural insolation, a diet low in calcium and vitamin D, smoking, consumption of large quantities of strong tea, coffee, and caffeine-containing tonics.

Pathogenesis

The effect on the bones of the pelvic ring of a load exceeding the tensile strength of bone tissue causes linear or splintered destruction of the mineral part and rupture of collagen fibers. In complete fractures, the fragments are displaced due to a reflex contraction of the muscles attached to them. Bone destruction leads to the formation of a hematoma in closed fractures and the onset of difficult-to-stop external bleeding in open ones. Massive blood loss can trigger the development of shock. At the site of injury, a protective inflammatory reaction occurs with edema, migration of leukocytes, and fibrin deposition.

Under the influence of osteoclasts, autolysis of the destroyed bone occurs, then the cells of the cambium of the periosteum, spongy substance, bone marrow and vascular adventitia begin to actively multiply. In place of the fallen fibrin threads, a protein matrix of cartilage is formed with its subsequent mineralization and replacement with strong bone tissue. The formed callus undergoes structural restructuring: first, the blood supply is restored, a compact substance is formed from the bone beams, then the microarchitecture of the bone is rebuilt taking into account the lines of force load, and the periosteum is formed.

Classification

The main criteria for systematizing pelvic fractures in pregnant women are the degree and nature of the damage, their location, time from the onset of injury, and the presence of complications. This approach allows us to standardize the pregnancy support plan for different types of injuries. Taking into account the integrity of the skin, a distinction is made between closed fractures without destruction of the skin and open ones with damage to soft tissues and communication with the environment. Pelvic injuries in pregnant women can be isolated, combined (with damage to the pelvic organs), multiple (combined with fractures in other anatomical areas), uncomplicated and complicated. To predict pregnancy outcome and develop obstetric tactics, it is important to determine how the fracture affected the integrity of the pelvic ring. Based on this criterion, they distinguish:

Marginal fractures. Parts of the bones that do not form the pelvic ring are damaged: the ischial tuberosities, the wing of the ilium, the coccyx, the part of the sacrum under the sacroiliac amphiarthrosis, the spines. In the absence of other injuries, it is considered the mildest type of pelvic injury. Continuation of gestation is possible with the provision of a protective regime, competent reposition and dynamic monitoring of the pregnant woman. Taking into account the patient's condition, natural delivery is acceptable.
Fractures without interruption of pelvic continuity. The bones that directly form the pelvic ring are damaged - the ischium, the branches of the pubic bone. The strength of the pelvis is reduced, but since both parts remain connected to the sacrum, both directly and through the other half, support is preserved. In the absence of other injuries, pregnancy can be prolonged; with stable fractures without displacement, natural childbirth is possible.
Fractures with disruption of pelvic continuity. Due to injury, each half of the pelvic ring has a one-sided connection with the sacrum, which significantly impairs the support of the pelvis. Due to the mobility of fragments, the risk of injury to the tissues of the birth canal and adjacent organs increases. For unstable fractures and displacement of fragments, a cesarean section is performed. Identification of a threat to the life of the mother or fetus serves as the basis for early delivery.

When deciding on the possibility of prolonging pregnancy and the option of its completion, the period of traumatic illness is taken into account. Specialists in the field of traumatology and orthopedics distinguish an acute reaction to a fracture (up to 2 days), early manifestations (up to 2 weeks), late manifestations (more than 2 weeks), and a rehabilitation period (until complete recovery). The shorter the period of time that has passed after a pelvic fracture, the more often surgical delivery is performed when indications for termination of pregnancy are identified or the due date is reached.

Symptoms of a fracture

The clinical picture is represented by local symptoms, altered gait or characteristic posture, general clinical and concomitant disorders. Local symptoms are intense pain in the affected area, pubis, and perineum, which usually intensifies with leg movements, pressure, and palpation. There is pelvic deformation, swelling, and visible bruising. In the presence of mobile fragments, bone crepitus is detected. Impaired motor activity and external signs are determined by the location and characteristics of the fracture.

With a traumatic avulsion of the anterosuperior iliac spine, the leg on the affected side is visually shortened due to the displacement of the fragment. To reduce pain, pregnant women with damaged ischial and superior branches of the pubic bone take the “frog pose”; if the posterior half-ring is ruptured, they lie on the healthy side. In patients with a damaged acetabulum, mobility in the hip joint is limited; with a combination of fracture and dislocation, the greater trochanter is displaced, and the leg is in a forced position.

Severe general symptoms with painful and hemorrhagic shock are detected in 30% of isolated pelvic fractures and in all patients with multiple, combined, and combined injuries. In severe cases, the skin becomes pale, covered in clammy sweat, the pulse quickens, and there is drowsiness, confusion, or loss of consciousness. In 10-20% of pregnant women, pelvic fractures are combined with damage to the urinary organs. Such injuries are characterized by urinary retention, the presence of blood in the urine, and complaints of pain in the urethra.

Complications

In 37% of pregnant women, the normal course of gestation is disrupted during an acute reaction to injury, in 25% - during the rehabilitation period. In 34.2% of cases, there is a threat of spontaneous termination of pregnancy or miscarriage, in 13.2% - premature birth. More than 40% of patients experience childbirth with complications. Since a pelvic fracture is often combined with blunt abdominal trauma, premature placental abruption with the development of disseminated intravascular coagulation syndrome, uterine rupture, and intra-abdominal bleeding are possible. In late gestation, when the fetal head is tightly fixed, the likelihood of fractures of the baby’s skull and limbs increases.

The perinatal mortality rate due to direct fetal head injury, shock in a pregnant woman, placental abruption ranges from 35 to 55.3%, depending on the severity of the fractures. Of particular danger to women are injuries involving rupture of the dilated veins of the cervix and massive hemorrhages in the parametrium or abdominal cavity. Long-term consequences of fractures of the pelvic ring bones are contractures, neuropathies, pelvic deformities, asthenia, and subdepressive disorders.

Obstetric complications are observed in patients who have suffered a fracture not only during the current gestation, but also in the past. With long-term post-traumatic changes, the risk of spontaneous miscarriages and premature birth reaches 45%. In 55% of cases, childbirth is complicated by untimely rupture of amniotic fluid, increasing fetal hypoxia, coagulopathic postpartum hemorrhage, and injuries to the cervix, vagina, and perineum. After childbirth, 45% of patients experience subinvolution of the uterus, endometritis and other purulent-inflammatory processes develop.

Diagnostics

A certain difficulty in identifying a pelvic ring fracture in pregnant women is the limited use of the most informative radiological research methods, which pose a potential threat to the development of the fetus. Taking into account the requirements of the Ministry of Health of the Russian Federation, pelvic radiography is permissible only after the 20th week of pregnancy, except in situations where a decision is made to terminate gestation or provide urgent care. In such cases, maximum protection of the child from radiation exposure is required. To confirm the diagnosis and detect possible complications, methods such as:

MRI of the pelvic bones. During magnetic resonance imaging, the fetus does not experience radiation exposure. In the first trimester of pregnancy, research is limited. MRI allows you to accurately visualize even small cracks and displacements of damaged pelvic bones and determine the degree of traumatic destruction of bone tissue.
Ultrasound of the uterus and fetus. Due to the high risk of losing the baby, ultrasound screening is a mandatory test for pelvic injuries. Using ultrasound, the condition of the fetus, placenta, and the integrity of the uterine wall are assessed. To detect possible violations of transplacental hemodynamics, the examination is supplemented with Dopplerography of uteroplacental blood flow.
Human chorionic gonadotropin content. Determining the hCG level over time provides high-quality monitoring of the course of pregnancy and is used when choosing the optimal tactics for patient management. A decrease in the indicator indicates a threat of miscarriage or antenatal fetal death.

If there are signs of shock, ongoing bleeding, or suspected placental abruption, the state of the hemostatic system must be assessed. To exclude a threat to the child, CTG, phonocardiography, and MRI of the fetus are additionally performed to identify possible bone injuries and intracranial hemorrhages. If damage to internal organs is suspected, culdoscopy, diagnostic laparoscopy, and cystoscopy are performed. Differential diagnosis is carried out with closed abdominal injuries without pelvic fracture. In addition to the obstetrician-gynecologist and traumatologist, the patient is examined by an abdominal surgeon, neurologist, and urologist.

Treatment of pelvic fractures in pregnant women

It is recommended that patients with a damaged pelvic ring be hospitalized in a multidisciplinary hospital to provide obstetric-gynecological, traumatological, and neonatological care. In the acute period, it is important to stabilize the condition of the pregnant woman, ensure reposition of fragments, and prevent complications of gestation. When drawing up a treatment plan, the traumatologist takes into account the duration of pregnancy, the nature of the damage, and the degree of displacement of bone fragments. From the moment of hospitalization in the hospital, the woman is prescribed intensive drug therapy:

Painkillers. For analgesia, drugs that are safe for the fetus are used. For moderate pain, nonsteroidal anti-inflammatory drugs are used; for severe pain, intrapelvic blockades with local anesthetics are possible. The prescription of narcotic analgesics is justified when signs of traumatic shock increase.
Infusion therapy. The introduction of crystalloid and colloid solutions is aimed at replenishing the volume of circulating blood, stabilizing hemodynamics, improving rheological parameters, and restoring microcirculation. If hemostasis deteriorates, the pregnant woman is given anticoagulants, protease inhibitors, and fresh frozen plasma is transfused.
Tocolytics. Drugs that relax the uterine muscles are usually used when there is a threat of interruption of gestation due to marginal and stable fractures. According to experts, tocolytic therapy is carried out in approximately 20-22% of patients. In case of severe injury, the effect of tocolytics on hemodynamic parameters is taken into account.

For stable fractures, no displacement or slight displacement, conservative management of the patient is indicated. The choice of reduction method is determined by the location and characteristics of the damage. For stable isolated and marginal fractures, the woman is fixed in a hammock or on a backboard. It is possible to use popliteal bolsters and Beler splints. For pregnant women with unstable fractures, skeletal traction and external or internal surgical fixation are recommended. Gestation is not considered a contraindication for surgery. Interventions with minimal radiation control are preferred. If the condition of the mother and fetus is satisfactory, in some cases it is possible to prolong gestation for several weeks and complete it on time with a natural birth.

Early delivery for health reasons (placental abruption, uterine injury, unstable fractures of the pelvic ring, severe polytrauma, terminal condition of the pregnant woman, signs of increasing fetal hypoxia) is carried out from the 28th week of gestation if the fetus is viable. In urgent situations, a cesarean section is usually performed; delivery through the birth canal is possible only with marginal or stable fractures with undisplaced fragments. To save the child when a pregnant woman dies, a post-mortem caesarean section is performed. Pelvic injuries suffered before pregnancy do not serve as an absolute indication for surgical delivery, which is performed in 61-64% of patients with post-traumatic changes in the pelvis.

Prognosis and prevention

The outcome of gestation with pelvic trauma is determined by the severity of the damage. The prognosis is often serious, especially in pregnant women with polytrauma, in which maternal and perinatal mortality rates reach 18.2% and 55.3%, respectively, severe disability is observed, and reproductive functions are impaired. Preventive measures are aimed at preventing possible injuries, including compliance with traffic rules at pedestrian crossings, when driving a car, refusal to perform professional and household duties involving work at height, wearing comfortable shoes with low, stable heels, and safe behavior in public places.

All reasons that can contribute to bone fractures can be divided into 2 groups - mechanical and pathological.

Mechanical reasons include:

Strikes;
Falling from one's own height;
Direct blow to the bone;
Electric shocks;
Falling on one's side;
Direct blow to the knee;
Leg twist;
Severe dislocation;
Overweight;
Heavy loads.

Pathological causes include:

Cancerous tumors in the skeletal system;
Metastasis of malignant neoplasms to bone;
Cysts in the bones;
Lack of vitamin D, calcium, fluorine and phosphorus;
Osteomyelitis;
Osteoporosis;
Increased fragility and fragility of bones.

Symptoms

The manifestation of clinical signs will depend on the location of the fracture. The development of symptoms will occur according to the following pattern:

Primarily as a result of a violation of the integrity of the bone and soft tissues, the expectant mother will experience severe, sharp or aching pain;
Next, edema develops due to damaged soft tissues and blood vessels, capillaries. In this case, the liquid is actively released from the bloodstream into the surrounding tissues. Hyperemia may occur. Swelling may be painful. This is due to greater pressure on the muscles and blood vessels of the edematous tissue;
The development of a subcutaneous hematoma can be determined by the characteristic bruise at the fracture site. It occurs as a result of crushing tissue, damage to the integrity of blood vessels, capillaries, both small and large. This leads to blood leaking into the surrounding space. Sometimes pathological accumulation of blood in joints and cavities is possible. Hematomas have a local elevated temperature. Upon palpation, fluctuation is noted. Sometimes the victim complains of a feeling of pulsation at the site of the hematoma. The hematoma develops from 1 hour to 1 day;
Hemarthrosis appears during intra-articular fractures and is characterized by pathological accumulation of blood in the joint cavity. This will lead to painful sensations in the joint, loss of motor activity, and deformation of the joint;
If the fracture occurs with the formation of fragments, then upon palpation the pathological mobility of the bone, as well as crepitus, is determined. However, in case of fractures this factor is determined extremely rarely due to severe pain in the victim;
Poor circulation in the damaged area can lead to numbness, the appearance of marbled skin, and ischemia;
If there is a loss of sensitivity below the fracture, the inability to move the damaged area (hand, foot), muscle paralysis and loss of motor function are possible;
Deformation of a limb manifests itself in a change in appearance; the arm or leg takes an unnatural forced position, in which pain is not so acutely felt. It is possible that the limb may increase in size;
A tear or rupture of the periosteum occurs, which will cause severe pain, since it contains a large number of nerve endings; Painful shock develops as a result of severe shock and pain; Shortening of the limb.

Diagnosis of a closed fracture in a pregnant woman

In connection with pregnancy, the expectant mother has to abandon many procedures and medications, but do and take something to deal with the existing threat to the fetus. For example, you should not take an x-ray in any trimester of pregnancy. However, if the mother’s health comes to the fore or there are acute indications, then an X-ray examination is performed. At the same time, all safety measures for the fetus are observed. Pictures are taken in frontal and lateral projections, capturing the joints that are located next to the fracture.

Magnetic resonance imaging is a safe and more modern method of research. This procedure is allowed for expectant mothers, both in the early stages of pregnancy and in the later stages. MRI makes it possible to determine the location of the fracture and the condition of the surrounding tissues.

If it is necessary to detect pathological accumulation of blood in joints or cavities, then ultrasound diagnostics is used.

Quite an interesting method for detecting microcracks using a tuning fork. This device is lightly struck against the surface. At the same time, the tuning fork begins to vibrate. At this time, it is brought to the site of the alleged violation of the integrity of the bone and leaned against it. With sharp and severe pain, one can judge the presence of microcracks.

Complications

Complications and consequences most often arise from improper treatment and depend on the characteristics of the body.

Treatment

What can you do

With a closed fracture, it is necessary to perform a number of simple manipulations. Both further treatment and the recovery process itself depend on timely first aid.

To begin with, you should try to calm the victim. For this you can use analgesics, sedatives;
In the presence of traumatic shock, conduct anti-shock therapy;
It is necessary to immobilize the patient by applying a splint or splint made from available material. At the same time, they should also be applied to nearby joints. This will prevent possible further displacement of the bones;
Next, the broken limb must be placed on an elevation in order to ensure the outflow of blood and reduce swelling;
If the spine is fractured, do not touch the victim.

It is worth remembering that under no circumstances should you set fractures yourself, pull the injured limb, or lift the victim.

An ambulance must be called.

What does a doctor do

If first aid was not provided, then emergency doctors apply a splint, administer local anesthesia, and give sedatives. Next, after the patient is taken to the hospital, doctors prescribe treatment. It can be conservative, and boils down to applying a plaster cast or tight bandaging. Possible skeletal traction. If surgery is indicated, the bones are collected manually and fixed using surgical instruments.

Prevention

All preventive measures are aimed at eliminating and preventing possible injuries and their consequences. To do this, the expectant mother follows simple rules, such as wearing comfortable shoes, vitamin therapy, and preventing diseases of the musculoskeletal system.

Falling during pregnancy is one of the main fears of pregnant women for good reason, but, unfortunately, it is impossible to completely insure yourself against this. Falling is especially likely during pregnancy in winter, when there is ice underfoot and the pregnant woman is wearing heavy winter clothes.

Injuries during pregnancy are especially common among lovers of high heels who cannot find the strength to part with them, and it’s good if it’s just a damaged ankle. A blow to the stomach during pregnancy is very dangerous, no matter how protective the baby’s nature is. Falling in the early stages of pregnancy is also dangerous, despite the fact that the baby is protected and located deep in the pelvic cavity.

What are the dangers of falling during pregnancy?

The pregnant woman becomes clumsy, in the later stages she does not even see where she is stepping, her tummy blocks her view. The gait becomes slow and careful, but still, it is very easy to lose balance.

Nature has provided for the possibility of injury during pregnancy.

A fall in the early stages does not directly harm the baby, because the uterus is reliably protected by the woman’s pelvic bones, and even a bruise in the abdomen during pregnancy up to 10-12 weeks most often does not affect the baby in any way.

A fall on the stomach during late pregnancy also usually does not lead to injury to the baby himself, he is surrounded by the amniotic sac and water softens even a direct blow.

But do not forget about the following factors:

A fall is always a sharp shock to the body, and it is not necessary to fall on your stomach. The body gets a shake-up in any case, even if the mother slipped and fell in the safest way.

Falling even on the “butt” during pregnancy is dangerous at any stage, since a sharp shaking of the house where the baby lives can lead to placental abruption and bleeding, and in the later stages, to damage to the amniotic sac.

Placental abruption often leads to the death of the child; in the long term, it also threatens the life of the mother.

A fall is fear, stress, and the release of a large amount of hormones into the blood, which can themselves cause a miscarriage. Pregnant women should not be scared or worried, anyone knows this.

A direct blow to the stomach during late pregnancy is only partially extinguished by amniotic fluid and fetal membranes. If the injury is serious, the child may suffer directly, that is, receive bruises and even fractures.

Impacts during pregnancy, inflicted on a pregnant woman intentionally, for example, as a result of beatings, quite often end sadly, with miscarriage and the death of the child.

Serious injuries during pregnancy, for example, spinal injuries, fractures, traumatic brain injury, can raise the question that now it is no longer the child who is most important, but his mother...

The consequences of a fall during pregnancy can be very serious, even if you just fall on your back. Of course, it is better to try to avoid injury, especially since in most cases this is possible by showing only forethought and caution.

Main rules if you are pregnant:

- give up high-heeled or platform shoes, buy yourself comfortable, high-quality shoes with non-slippery, stable soles.
- avoid walking in areas where it is obviously slippery and where you could fall.
- go down and up the stairs, without neglecting the railings, they were invented for this purpose, so that you could insure yourself from troubles.
- icy conditions on the street are a sufficient reason for you not to walk alone, the reliable hand of a companion is the best protection against falls.
- do not carry bags, keep your hands free.
- Avoid restricting movement and uncomfortable clothing.
- if you start to fall, grab onto everything that is nearby without hesitation. Even if a person unknown to you supports you, there should be no embarrassment, you are pregnant, and any person is simply obliged to help you if you need it.

And lastly, learn to fall correctly. Don’t smile, you can also fall correctly during pregnancy; if you attended any martial arts class, you would be taught how to fall correctly first of all. To minimize the risk of injury from a fall, even if you fall on your back or stomach, at the very moment of the fall you have the necessary split second to twist and fall on your side. It's safer. If you fall on your side, you definitely won't break anything or hit your head. Never extend your arms forward when falling; if you fall on your arm, you risk getting a fracture. When falling, say, on your left side, the movement of your left hand should be directed, it should not end up under you and take the blow. Correctly and safely, if it turns out to be extended to the side and takes a blow when falling flat, you should, as it were, slam your whole hand on the ground, the load will be distributed not along the axis of the limb, but along it, and you will avoid a fracture.

What to do if a woman still falls during pregnancy?

First of all, you need to assess the consequences.

Simple bruises during pregnancy are no more dangerous than at any other time; you should not be afraid of ordinary bruises, it is important that your child is not injured.

If you manage to fall on your stomach, consult a gynecologist just in case, even if nothing worries you.

Whether a fall during pregnancy is dangerous for a child in each specific case can be determined by a number of symptoms:

Bruises during early pregnancy:

- discomfort in the lower abdomen
- any discharge from the genital tract, bloody, brown, beige, even if it is just a small spot.

Impacts during advanced pregnancy:

- uterine tone, abdominal pain
- change in the nature of fetal movements, both intensification and subsidence of motor activity.
- any discharge from the genital tract. Particularly noteworthy is the possibility of damage to the amniotic bladder and leakage of amniotic fluid. When leaking, water may be released in very small quantities; you will feel it as a feeling of dampness, which intensifies with movement.

Women can suffer other injuries during pregnancy. While almost everyone falls during pregnancy, but complications are extremely rare, some particularly unlucky pregnant women end up in more unpleasant situations. Burns during pregnancy, electric shock, serious injuries from road accidents and much more await anyone, you just have to relax and stop being careful.

Take care of yourself and your baby, life is full of dangers, and you are responsible for both...